The ability of antigens to induce protective immune responses in a host can be enhanced by combining the antigen with immunostimulants or adjuvants. Alum-based adjuvants are almost exclusively used for licensed injectable human vaccines, however, while alum enhances certain types of serum antibody responses (Type 2), it is poor at enhancing other types of antibody responses (Type 1) and is a poor activator of cellular immune responses that are important for protection against intracellular pathogens and for therapeutic vaccines for cancer and allergy. Furthermore, alum enhances allergic reactions due to production of IgE. Although numerous substances have been tested and shown to be potent adjuvants for antibody and cellular (Type 1) immune responses in animal models, very few have proved to be suitable for use in humans due to unacceptable levels of reactogenicity and/or disappointing immuno-enhancing abilities. Furthermore, there are currently no licensed adjuvants capable of enhancing immune responses at mucosal surfaces where the majority of infectious agents enter the host. Indeed, development of the most promising nasally delivered mucosal adjuvants, the bacterial enterotoxins (e.g. mutated cholera and heat-labile toxins), have been halted in North America due to their ability to be transported to, and cause inflammation in the olfactory bulb region of the CNS of rodents. There is a need for potent adjuvants that are safe in humans and capable of inducing protective systemic and mucosal humoral and cellular immune responses.
Lipopolysaccharides (LPS) from gram negative bacteria are potent adjuvants. LPS activates the innate immune system causing production of inflammatory cytokines such as IL-1, TNF-□, IL-10 and IL-12 from macrophages and dendritic cells; IL-1, IL-6 and IL-8 from endothelial cells and IL-8 from epithelial cells. In addition, LPS is a B cell activator in mice and, to a certain extent in humans, as evidenced by B cell mitogenicity and stimulation of polyclonal antibody secretion. LPS mediates it's effects by binding to CD14 molecules and activation of toll like receptors (TLR) on the surface of antigen presenting cells leading to the initiation of a transcriptional cascade, gene expression and secretion of pro-inflammatory molecules.
Despite the adjuvant potential of LPS, its use in humans has been restricted due to the associated endotoxicity mediated by the lipid A portion of the molecule. Chemical modification of the lipid A region of LPS was shown to substantially detoxify lipid A (e.g. monophosphoryl lipid A or MPL-A or e.g. alkali-detoxification to remove certain fatty acids) while maintaining certain adjuvant properties (see Qureshi et. al. J. Biol Chem 1982; 257:11808-15). While MPL-A exhibited potent adjuvant activity in animals, the experience in humans has been inconsistent, showing poor adjuvant activity with some antigens and unacceptable reactogenicity overall in many situations.
Non-covalent proteosome-LPS complexes, containing proteosomes from Neisseria meningitidis and purified LPS from Shigella flexneri or Plesiomonas shigelloides, have been administered to humans intranasally and orally in phase 1 and phase 2 clinical trials in the context of stand-alone vaccines. These vaccines induce protective immune responses against Shigella flexneri or S. sonnei infection, respectively, in animals (Mallet et. al. Infect and Immun 1995; 63:2382-86) and humans (Fries et. al. Infect Immun. 2001; 69:4545-53) when given via the intranasal route. Further, these complexes were well-tolerated via the nasal or oral routes in humans at very high doses (up to 1.5 mg of proteosomes along with comparable amounts of LPS given intranasally and up to 2 mg of each of the proteosome and LPS components given orally) (Fries et. al. 2000) and showed no olfactory bulb or other CNS associated toxicity in small animal toxicity studies. Proteosomes consist predominantly of porin proteins and other outer membrane proteins. Evidence suggests that proteosome porins may also induce IL-12 from dendritic cells and induction of CD8+ T cells (Jeannin et. al. Nature Immunology 2000; 1:502-509) and activation of Hela cells to produce IL-8 (Pridmore et. al. J. Infect Dis 2000; 10:183). Proteosome porins also upregulate B7.2 (CD28) co-stimulatory molecules on antigen presenting cells via the activation of the toll-like receptor 2 (Massari et. al. J. Immunol. 2002, 168:1533-1537).
Dalseg et. al. (in Vaccines 96 pp. 177-182 (Cold Spring Harbor laboratory Press, 1996)) report the use of meningococcal outer membrane vesicles (OMV's) as a mucosal adjuvant for inactivated whole influenza virus. Dalseg and his associates and collaborators have reported that the OMV's they prepare employ a process that retains 6% to 9% of endogenous lipooligosaccharide (LOS) remaining compared to the amount of total OMV protein by weight. These OMV preparations have also been reported to specifically retain 16% of detergent (deoxycholate) in their OMV's, an amount that may be unhealthy or toxic in toxicity studies or in humans.